The classical treatment for severe and symptomatic stenosis of the internal carotid is carotid endarterectomy. An endarterectomy within two weeks after the initial symptoms of a TIA or CVA decreases the chances of new ischaemic symptoms. However, there is now an alternative for this operation, namely the placement of an endovascular stent. Although this method offers some advantages, there are still insufficient prospective randomised trials to prove that this technique is just as suitable as the classical method. Various studies are now in progress to evaluate the short- and longterm results of endovascular treatment in comparison with endarterectomy. For the time being, therefore, stent placement should only be done in the context of clinical trials.